PROJECT SUMMARY Fewer than half of older adults receive high quality end-of-life care, however not much is known about the quality of end-of-life care experienced by the segment of that population with multiple chronic conditions (MCC). Older adults with MCC face unique challenges at the end of life, but few studies explicitly examine their end-of-life care quality. Failure to address the gap in knowledge regarding end-of-life care quality for older adults with MCC could lead to ineffective improvements or policies mismatched with the populations' needs and priorities. This retrospective cross-sectional cohort study investigates the end-of-life care quality experienced by older adults with MCC using the nationally representative National Health and Aging Trends Study (NHATS) Last Month of Life Interview (LMLI). In the LMLI, designated proxies rate overall end-of-life care quality for deceased NHATS participants and report their perception of care in five end-of-life quality domains ( symptom management, shared decision-making, respect, coordination, and spiritual and emotional support). The study's objectives are to assess the presence of MCC as a potential driver of poor end-of-life care quality and inform end-of-life care improvements that meet the needs and interests of older adults with MCC. To meet the objectives, Aim 1 will identify disparities in proxy-reported end-of-life care quality for older adults with MCC compared to those without MCC. Aim 2 will determine which of the five recognized end-of-life quality domains are associated with excellent overall end-of-life care quality for older adults with MCC. Aim 3 will evaluate the relationship between positive perception of care in the coordination quality domain and positive perception of care in other recognized quality domains for older adults with MCC. Findings from this study will: 1) identify whether end-of-life care quality for older adults differs by MCC status, 2) contribute information for prioritizing patient-centered end-of-life care quality improvements, and 3) suggest whether coordination, a strategy that has shown promise for improving care quality prior to end of life, also improves end-of-life care quality for older adults with MCC.The study aligns with AHRQ's mission and strategy by addressing three priority areas: elderly individuals, chronic care, and end-of-life care.